Balloon Angioplasty: A New Treatment Modality For Neurogenic Thoracic Outlet Syndrome
Jenny Wang, Meghan He, Snehal Bindra, Lauren Jones, Sam Ahn.
University Vascular Associates, Los Angeles, CA, USA.
Objective: Recent previous studies from Los Angeles suggest that percutaneous transluminal angioplasty (PTA) of the head and neck veins may provide an effective alternative to open surgical decompression of the thoracic outlet space for Neurogenic Thoracic Outlet Syndrome (NTOS). We report herein a cohort of Dallas patients to verify the safety and efficacy of venography and PTA as a treatment method for NTOS.
Methods: Charts of 1194 consecutive patients from 2010 to 2019 who presented with NTOS symptoms were retrospectively analyzed. Mean follow-up period was 591 days, ranging from 0 and 2988 days. Symptom improvement and reintervention rate were recorded. All patients underwent conservative physical therapy, and those who failed physical therapy underwent diagnostic venography to assess for venous compression at the thoracic outlet. Patients who had venous compression were treated with simultaneous PTA.
Results: Of the total 1194 patients, 307 (mean age=51 years, SD=13 years, 72% female and 28% male) patients failed physical therapy and underwent diagnostic venography. Of these 307 patients, 291 (95%) were found to have significant subclavian and/or internal jugular vein stenosis and were treated with PTA. Following PTA, 179 patients (61%) reported initial symptomatic improvement, 63 (22%) had no change, and 49 (17%) deteriorated. Furthermore, 148 patients (51%) had no subsequent treatment, 38 (13%) had additional endovascular intervention, and 105 (36%) eventually had open surgery. Complication was seen in only one patient (0.3%) with brief asymptomatic ventricular tachycardia in the recovery room who was then admitted for observation, remained stable, and discharged the next day. Overall, of the 291 patients treated with PTA, 186 (64%) avoided open surgery.
Conclusions: PTA is a safe and effective treatment, reducing the need for open surgery in almost two-thirds of the patients, and thus should be considered prior to surgery. This finding, from a cohort of Dallas patients with different compositions of race and socioeconomic status than the previous Los Angeles patient cohort, provides further evidence of the efficacy of PTA.
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